Enlarged Submandibular Lymph Nodes: When to Worry?

Q: Enlarged Submandibular Lymph Nodes: When to Worry?

Hello： If you have already undergone ultrasound and fine needle aspiration examinations, and both results show benign changes, it is recommended to have regular follow-up observations. <br>Wishing you peace and health. <br>Sincerely, Dr. <br>Cheng Jue-Yi, Director of the Departme

Enlargement of the submandibular lymph nodes?

Hello Dr.
Cheng! I would like to ask you about a situation.
In mid-March of this year, I suddenly noticed a lump in my neck under the jaw.
I wasn't sure if it had been there before.
I went to Hospital A, where the doctor examined me and said it was about 1.1 cm.
They then conducted blood tests, a chest X-ray, and a nasal endoscopy.
After the examinations, the doctor informed me that aside from elevated white blood cell counts, everything else was normal.
Later, I consulted another doctor at the same hospital who performed a fine needle aspiration biopsy.
The results indicated the presence of inflammatory cells, and the doctor advised me to return for follow-up every two months.
My most recent follow-up appointment was on August 13, where the doctor noted that the lump had neither increased nor decreased in size, which provided some reassurance.
However, I was still concerned, so I sought a second opinion at Hospital B.
The doctor there mentioned that, in his view, lymph nodes in that area can naturally be larger and that it should be fine.
At my request, he also arranged for a neck ultrasound.
After the ultrasound, the doctor said it looked fine, measuring approximately 1.6 x 0.6 cm, and did not perform a fine needle aspiration.
When I asked if I needed to return for follow-up, the doctor at this hospital said it was not necessary.
I would like to ask Dr.
Cheng for your advice regarding my situation.
Should I continue to monitor it? Additionally, is it normal for lymph nodes under the jaw to be this large, exceeding 1 cm? Thank you very much for your explanation and advice.
Thank you!

Hei Ji Ta, 40~49 year old female. Ask Date: 2016/08/19

Dr. Zheng Jueyi reply Otolaryngology

Hello: If you have already undergone ultrasound and fine needle aspiration examinations, and both results show benign changes, it is recommended to have regular follow-up observations.
Wishing you peace and health.
Sincerely, Dr.
Cheng Jue-Yi, Director of the Department of Otolaryngology, Taoyuan Hospital, Ministry of Health and Welfare.

Reply Date: 2016/08/19

More Info

When it comes to enlarged submandibular lymph nodes, it’s understandable to feel concerned, especially after multiple evaluations and varying opinions from different healthcare providers. Based on the information you've provided, it appears that your lymph node has been monitored over time, and while it has shown some size (approximately 1.1 cm initially and later 1.6 x 0.6 cm), the assessments from your doctors have generally indicated that there is no immediate cause for alarm.

Understanding Lymph Node Enlargement
Lymph nodes can enlarge for various reasons, including infections, inflammation, or malignancy. In your case, the presence of inflammatory cells in the fine needle aspiration (FNA) suggests that your lymph node enlargement may be due to a reactive process, likely related to an infection or inflammation in the area. This is a common scenario, especially in the submandibular region, where lymph nodes can react to dental issues, upper respiratory infections, or other localized infections.

Size Considerations
Regarding the size of your lymph node, it is important to note that lymph nodes can vary significantly in size. Normal lymph nodes are typically less than 1 cm in diameter, but it is not uncommon for lymph nodes in certain areas, such as the submandibular region, to be larger, especially in response to inflammation or infection. A lymph node measuring over 1 cm does not automatically indicate malignancy; many benign conditions can cause lymph nodes to enlarge.

Follow-Up Recommendations
Given that your lymph node has not changed significantly in size over the past few months and that multiple healthcare providers have assessed it without finding malignancy, it seems reasonable to continue with periodic monitoring. The recommendation from your last doctor not to pursue further follow-up may be based on their assessment that the lymph node is stable and does not exhibit characteristics of malignancy.

However, if you continue to feel anxious about the situation, it is perfectly acceptable to seek a second opinion or to request follow-up imaging or evaluations. Regular follow-up can provide peace of mind, especially if you notice any changes in the lymph node or develop new symptoms.

When to Worry
You should be vigilant for any signs that might warrant further investigation, such as:
- Rapid increase in size of the lymph node
- Development of new lymph nodes in other areas
- Persistent fever, night sweats, or unexplained weight loss
- Symptoms of infection that do not resolve
If any of these occur, it would be prudent to consult your healthcare provider promptly.

Conclusion
In summary, while your enlarged submandibular lymph node has raised concerns, the evaluations you have undergone suggest that it is likely reactive rather than malignant. Continuing to monitor the lymph node with periodic check-ups is a reasonable approach, especially given the stable nature of the lymph node. If you have any lingering concerns or if your symptoms change, don’t hesitate to reach out to your healthcare provider for further evaluation. Your health and peace of mind are paramount, and it’s important to feel comfortable with your care plan.

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